Medicaid HCBS waivers

What waivers cover

HCBS waivers fund the supports that make it possible to live in the community rather than in an institution. Common covered services include:

• Personal care aides and direct support professionals
• Respite care for family caregivers
• Supported employment and job coaching
• Assistive technology and home modifications
• Day programs and community inclusion activities
• Residential supports in supported living arrangements

Waivers do not typically cover room and board — the cost of housing or food — or general medical care (that is covered by regular Medicaid). Each state defines its own list of covered services, so the specific services available to your family depend on your state's waiver design.

Eligibility

HCBS waiver eligibility has two parts. First, financial eligibility: you must meet your state's Medicaid income and resource limits. These vary by state; many states have expanded Medicaid under the ACA, which broadens eligibility. Second, a level-of-care determination: typically the same level of care that would qualify someone for a nursing facility or intermediate care facility. Autism and significant intellectual disability generally meet this standard.

Most states have separate waivers for different populations — a children's waiver, a developmental disability waiver, a traumatic brain injury waiver. Ask specifically which waiver covers autism or developmental disabilities in your state.

Applying

Contact your state's Medicaid agency or developmental disabilities (DD) agency and ask how to apply for HCBS waiver services. The application process usually involves: completing an application (paper or online), a level-of-care assessment conducted by a state or county worker, and a financial eligibility review.

In most states, being placed on a waitlist is a separate step from being found eligible for services. You can often get on the waitlist before completing the full eligibility determination — and the waitlist date is what matters most. Ask explicitly: "How do I get on the waitlist, and does waitlist placement require full eligibility?"

Find your state's Medicaid and DD agency contacts on your state hub page.

While you wait

Being on a waitlist doesn't mean you have no access to services. While waiting for a waiver slot:

• State plan Medicaid may cover therapy (ABA, OT, speech), durable medical equipment, and some behavioral health services without a waiver. Ask your state Medicaid office what your child qualifies for under the standard Medicaid state plan.
• School-based services under IDEA are available at no cost until age 21 (or graduation) and do not require Medicaid eligibility.
• Early Intervention (under age 3) is a separate federal program with its own eligibility — see Finding therapy.
• County or regional DD programs sometimes provide services without a waiver slot — ask your county DD office what's available without waiting.